Substance Use

Action on Smoking and Health estimates smoking causes around 76,000 deaths a year in the UK and is the leading single cause of preventable illness and early death. ONS data show 10.6% of UK adults smoked cigarettes in 2024 — the lowest rate since records began in 2011 — though rates remain markedly higher in routine and manual occupations and in more deprived areas.^[1]ASH[2]ONS

NICE guideline NG209 recommends offering everyone who smokes a combination of behavioural support and pharmacotherapy (varenicline, NRT or bupropion; or, since 2024, cytisine), with NHS Stop Smoking Services roughly doubling the chance of successful quitting compared with unaided attempts.^{[6]NICE NG209}

The 2016 UK Chief Medical Officers' guideline advises that, to keep health risks low, adults should drink no more than 14 units a week, spread over three or more days, with several alcohol-free days each week. The CMOs explicitly state there is no level of regular drinking that can be considered completely safe.^{[3]UK CMOs 2016}

ONS data show 10,473 alcohol-specific deaths were registered in the UK in 2023 — the highest figure on record, though the age-standardised death rate (15.9 per 100,000) fell slightly compared with 2022.^{[4]ONS 2025}

A 2022 Lancet Global Burden of Disease analysis found that for adults aged 15–39, zero standard drinks per day minimised health risk; for adults over 40 without underlying conditions, the estimated low-risk level was up to ~1–1.75 standard drinks per day, varying by region and sex.^{[7]GBD / Lancet 2022}

OHID's annual statistics on adult substance-misuse treatment in England report around 290,000 adults in treatment in 2022–23, with opiate dependence the most common primary problem. Drug-poisoning deaths in England and Wales registered by ONS have more than doubled since 2012, driven by opiates and increasingly by synthetic opioids.^[5]OHID

For opioid dependence, NICE recommends opioid agonist therapy with methadone or buprenorphine, combined with psychosocial intervention, as the mainstay of treatment — substantially reducing both illicit use and overdose mortality. For alcohol dependence, NICE recommends a combination of psychosocial intervention plus relapse-prevention medication (acamprosate, naltrexone or, in some cases, disulfiram).^[6]NICE

In primary care, a brief alcohol intervention — a structured 5–10 minute conversation triggered by an AUDIT score — produces small but reliable reductions in consumption, and is part of the NHS Health Check.^[5]OHID